As we are becoming more aware of the fact that hormones may have a significant impact on women’s libidos, testosterone has begun to play a more important role in evaluation and treatment. Testosterone is typically thought of as a male hormone but lower levels may also be critical to a woman’s health and wellbeing. For years research has supported the fact that testosterone replacement therapy in men significantly impacts libido, bone density, energy levels and mood, so practitioners experimented with small amounts of testosterone replacement and began to see significant and sometimes dramatic outcomes.

These positive results lead to the use of testosterone therapy for low libido (or low desire) in women. Its use is becoming more common and research on post-menopausal women have shown positive results. Those of us in the field can tell you from our practical experience with thousands of patients with low libido: testosterone can and does work to raise a woman’s desire and interest in sex.

After nearly eleven years in practice here’s what we can tell you about testosterone:

  • Testosterone is a hormone and can replace or boost your hormone levels and influence the way you feel about sex.
  • Testosterone can’t make you and your partner fight less (unless your fighting has to do with a lack of sex).
  • Testosterone can’t work through past sexual abuse issues for you.
  • Testosterone can’t make you less angry at your partner.

This means you cannot use testosterone replacement to solve psychological or relationship issues or control other aspects of your life that seem unfulfilling. Essentially, you need to work with a practitioner who will help you to identify all the factors that are contributing to your low libido and help you work on each of them in the most appropriate and productive way.

Bear in mind is that using testosterone on women is fairly new. Drug companies and the FDA are hesitant to set up large-scale testing on women because hormone therapy is complicated and may have negative consequences. As a result, there is not a great deal of information on long term effects of using testosterone replacement, although there are no conclusive areas of concern in its use either. When mild short term side effects do surface, they are addressed with proper monitoring of typically low dosage.

The good news is that if the problem really is hormonal, or even partially hormonal, we see excellent results when we use testosterone. It is a useful tool for many of our patients because, let’s face it, no amount of therapy, sweet talk or good communication will really help your libido if you’re walking around with the hormonal profile of a 10 year old. You just won’t be interested in sex.

So if you think the problem may be hormonal (and in my 10 years of practice I have come to trust women’s own instincts) you might want to consider talking to a practitioner about testosterone replacement therapy.

What does testosterone treatment look like?

The bioidentical testosterone products that we prescribe come in gel or pellet form. The gel is applied topically to the thigh and the pellet is inserted subcutaneously into the buttocks. For women who have never used testosterone before we recommend starting with the gel since it is easier to dose at smaller amounts and we can slowly titrate up to avoid potential side effects. Pellet insertion is a great option for women who have been on testosterone for a while and the side effect profile is known since once the pellet is inserted it cannot be removed.  

What are typical side effects of testosterone?

Many women do not experience side effects from testosterone supplementation but if they do the side effects are usually reversible if the dosage is reduce or discontinued. The most common side effect that we see is hair growth which is usually only at the site of the testosterone gel application. Some women may notice their leg or facial hair grows back a little faster. Other possible but rare side effects include acne, hair loss on head, increase in cholesterol, aggressive behavior, voice deepening and clitoral enlargement. Again these side effects are very rare and are more likely is a woman who use higher than normal doses of testosterone for a long period of time.

Many women are fearful of hormones and cancer. There is no direct link between testosterone supplementation and cancer. Several studies show testosterone to be breast protective.

It is important to note that getting pregnant while undergoing testosterone supplementation is contraindicated so using a reliable form of birth control is necessary.

How effective is testosterone treatment?

Testosterone supplementation is a very effective treatment for low desire especially in conjunction with behavioral therapy. Multiple randomized placebo controlled clinical trials show that low dose testosterone treatment is efficacious in women.